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Abstract

Background: Severe sepsis in pediatric patients remains a critical challenge in intensive care, with high morbidity and mortality rates. Identifying reliable, cost-effective prognostic markers is essential for timely risk stratification and intervention. Serum ferritin, an acute-phase reactant, has emerged as a potential predictor of adverse outcomes, though its diagnostic utility in children with sepsis requires further validation. Objective: To evaluate the diagnostic accuracy of serum ferritin in predicting adverse outcomes in pediatric patients with severe sepsis taking non survivors as gold standard. Study Design: Cross-sectional validation study. Duration and Place of Study: The study was conducted from May 2023 to December 2023 in the Paediatric Intensive Care Unit (PICU) at Combined Military Hospital, Abbottabad. Methodology: A total of 186 pediatric patients between the ages of 1 month and 12 years with confirmed severe sepsis were enrolled using consecutive non-probability sampling. Serum ferritin concentrations were assessed within the first 48 hours following admission to the pediatric intensive care unit (PICU) through a chemiluminescent immunoassay method. A threshold of 558 ng/mL or higher was applied to indicate a likelihood of adverse outcomes. Results: The average age of the participants was 5.66 ± 3.55 years, with a male-to-female ratio of 1.4:1. Out of the 186 cases, serum ferritin exhibited a sensitivity of 63.04%, specificity of 75%, positive predictive value (PPV) of 45.31%, negative predictive value (NPV) of 86.07%, and an overall diagnostic accuracy of 72.04%. Stratified analyses showed higher diagnostic performance in children ≤8 years and in those with illness duration ≤7 days. Conclusion: Serum ferritin is a moderately accurate, non-invasive prognostic biomarker for adverse outcomes in pediatric severe sepsis, particularly when integrated with clinical assessment.